Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants： a meta-analysis

SHI Huiling; JIA Yanping; REN Yi

doi:10.6039/j.issn.1001-0408.2023.10.19

您当前的位置：

首页 >

文章列表页 >

Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants： a meta-analysis

更新时间：2025-09-27

- Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants： a meta-analysis
- ZHONGGUO YAOFANG Vol. 34, Issue 10, Pages: 1252-1256(2023)
- 作者机构：
  
  1.海口市妇幼保健院儿童保健部，海口　570203
  2.海口市妇幼保健院新生儿科，海口　570203
  3.海口市妇幼保健院儿内科，海口　570203
- 作者简介：
- 基金信息：
- DOI：10.6039/j.issn.1001-0408.2023.10.19
  CLC： R974;R722.6
- Received：25 August 2022，
  
  Revised：2023-03-06，
  
  Accepted：14 March 2023，
  
  Published：30 May 2023
- 稿件说明：
移动端阅览
施慧玲,贾雁平,任翼.小剂量氢化可的松防治极早产儿支气管肺发育不良有效性和安全性的Meta分析[J].中国药房,2023,34(10):1252-1256.

SHI Huiling,JIA Yanping,REN Yi.Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants： a meta-analysis[J].ZHONGGUO YAOFANG,2023,34(10):1252-1256.
施慧玲,贾雁平,任翼.小剂量氢化可的松防治极早产儿支气管肺发育不良有效性和安全性的Meta分析[J].中国药房,2023,34(10):1252-1256. DOI： 10.6039/j.issn.1001-0408.2023.10.19.

SHI Huiling,JIA Yanping,REN Yi.Efficacy and safety of low-dose hydrocortisone for the prevention and treatment of bronchopulmonary dysplasia in very premature infants： a meta-analysis[J].ZHONGGUO YAOFANG,2023,34(10):1252-1256. DOI： 10.6039/j.issn.1001-0408.2023.10.19.

摘要

目的

系统评价极早产儿早期预防性使用小剂量氢化可的松（HC）防治支气管肺发育不良（BPD）的有效性和安全性，为临床治疗提供循证参考。

方法

计算机检索PubMed、Embase、Web of Science、Cochrane图书馆、中国期刊全文数据库、中文科技期刊数据库、万方数据，收集极早产儿早期预防性使用小剂量HC（试验组）对比安慰剂或多巴胺（对照组）的随机对照试验（RCT）。检索时限均为建库起至2022年6月。筛选文献、提取资料后采用Cochrane系统评价员手册推荐的6.2偏倚风险评估工具对纳入文献质量进行评价；采用RevMan 5.3软件进行Meta分析、敏感性分析和发表偏倚分析。

结果

共纳入9篇RCT，总计1 437例极早产儿。Meta分析结果显示，试验组患儿的BPD发生率[OR＝0.75，95%CI（0.58，0.95），

＝0.02

]

、病死率[OR＝0.72，95%CI（0.54，0.97），

＝0.03

]

均显著低于对照组，无BPD生存率[OR＝1.36，95%CI（1.06，1.74），

＝0.02

]

、胃肠道穿孔发生率[OR＝2.23，95%CI（1.31，3.78），

＝0.003

]

、败血症发生率[OR＝1.27，95%CI（1.01，1.60），

＝0.04

]

均显著高于对照组；两组患儿的坏死性小肠结肠炎、脑室旁白质软化、脑室内出血、动脉导管未闭、高血糖、气胸、早产儿视网膜病发生率比较，差异均无统计学意义（

＞0.05）。敏感性分析结果显示，所得结果稳健。发表偏倚分析结果显示，本研究存在发表偏倚的可能性较小。

结论

极早产儿早期预防性使用小剂量HC可减少BPD的发生，降低病死率，提高无BPD生存率，但需注意胃肠道穿孔和败血症的发生。

Abstract

OBJECTIVE

To systematically evaluate the efficacy and safety of prophylactic use of low-dose hydrocortisone （HC） for the prevention and treatment of bronchopulmonary dysplasia （BPD）， and to provide evidence-based reference for clinical treatment.

METHODS

PubMed， Embase， Web of Science， Cochrane Library， CJFD， VIP and Wanfang databases were searched by computer； randomized controlled trials （RCT） about prophylactic use of low-dose HC （trial group） versus placebo or dopamine （control group） in very premature infants were collected from the establishment of the database to Jun. 2022. The quality of the included literature was evaluated by using bias risk assessment tool recommended by Cochrane system evaluator’s manual （version 6.2） after screening the literature and extracting the data. Meta-analysis， sensitivity analysis and publication bias analysis were carried out with RevMan 5.3 statistical software.

RESULTS

A total of 1 437 very premature infants were included in 9 RCTs. Meta-analysis showed that the incidence of BPD [OR＝0.75， 95%CI（0.58，0.95），

＝0.02

]

and fatality [OR＝0.72， 95%CI （0.54，0.97），

＝0.03

]

in trial group were significantly lower than control group； the survival rate without BPD [OR＝1.36， 95%CI （1.06，1.74），

＝0.02

]

， the incidences of gastrointestinal perforation [OR＝2.23， 95%CI （1.31，3.78），

＝0.003

]

and sepsis [OR＝1.27， 95%CI （1.01，1.60），

＝0.04

]

in trial group were all significantly higher than control group. There was no significant difference in the incidence of necrotizing enterocolitis， paraventricular leukomalacia， intraventricular hemorrhage， patent ductus arteriosus， hyperglycemia， pneumothorax， retinopathy of premature infants between the two groups （

＞0.05）. Results of sensitivity analysis showed that study results were robust. Results of publication

bias analysis showed that there was little possibility of publication bias in this study.

CONCLUSIONS

The early prophylactic use of low-dose HC can reduce BPD in very premature infants， reduce fatality， and improve the survival rate without BPD， but we should pay attention to gastrointestinal perforation and sepsis.

关键词

Keywords

references

HIGGINS R D ， JOBE A H ， KOSO-THOMAS M ， et al . Bronchopulmonary dysplasia：executive summary of a workshop [J ] . J Pediatr ， 2018 ， 197 ： 300 - 308 .

STOLL B J ， HANSEN N I ， BELL E F ， et al . Trends in care practices，morbidity，and mortality of extremely preterm neonates，1993-2012 [J ] . JAMA ， 2015 ， 314 （ 10 ）： 1039 - 1051 .

TWILHAAR E S ， WADE R M ， DE KIEVIET J F ， et al . Cognitive outcomes of children born extremely or very preterm since the 1990s and associated risk factors：a meta-analysis and meta-regression [J ] . JAMA Pediatr ， 2018 ， 172 （ 4 ）： 361 - 367 .

BHANDARI V . Postnatal inflammation in the patho-genesis of bronchopulmonary dysplasia [J ] . Birth Defects Res A Clin Mol Teratol ， 2014 ， 100 （ 3 ）： 189 - 201 .

DELARA M ， CHAUHAN B F ， LE M L ， et al . Efficacy and safety of pulmonary application of corticosteroids in preterm infants with respiratory distress syndrome：a systematic review and meta-analysis [J ] . Arch Dis Child Fetal Neonatal Ed ， 2019 ， 104 （ 2 ）： F137 - F144 .

PHAROAH P D . Dexamethasone treatment and cerebral palsy [J ] . Arch Dis Child Fetal Neonatal Ed ， 2001 ， 84 （ 2 ）： 140 Fa-140.

HALLIDAY H L . Early postnatal dexamethasone and cerebral palsy [J ] . Pediatrics ， 2002 ， 109 （ 6 ）： 1168 - 1169 .

SHINWELL E S ， KARPLUS M ， BADER D ， et al . Neonatologists are using much less dexamethasone [J ] . Arch Dis Child Fetal Neonatal Ed ， 2003 ， 88 （ 5 ）： F432 - F433 .

DOYLE L W ， CHEONG J L ， EHRENKRANZ R A ， et al . Early（＜ 8 days）systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants [J ] . Cochrane Database Syst Rev ， 2017 ， 10 （ 10 ）： CD001146 .

OFMAN G ， PEREZ M ， FARROW K N . Early low-dose hydrocortisone：is the neurodevelopment affected? [J ] . J Perinatol ， 2018 ， 38 （ 6 ）： 636 - 638 .

WATTERBERG K L ， GERDES J S ， COLE C H ， et al . Prophylaxis of early adrenal insufficiency to prevent bronchopulmonary dysplasia：a multicenter trial [J ] . Pediatrics ， 2004 ， 114 （ 6 ）： 1649 - 1657 .

ALISON M ， TILEA B ， TOUMAZI A ， et al . Prophylactic hydrocortisone in extremely preterm infants and brain MRI abnormality [J ] . Arch Dis Child Fetal Neonatal Ed ， 2020 ， 105 （ 5 ）： 520 - 525 .

BAUD O ， MAURY L ， LEBAIL F ， et al . Effect of early low-dose hydrocortisone on survival without bronchopulmonary dysplasia in extremely preterm infants（PREMILOC）：a double-blind，placebo-controlled，multicentre，randomised trial [J ] . Lancet ， 2016 ， 387 （ 10030 ）： 1827 - 1836 .

BONSANTE F ， LATORRE G ， IACOBELLI S ， et al . Early low-dose hydrocortisone in very preterm infants：a randomized，placebo-controlled trial [J ] . Neonatology ， 2007 ， 91 （ 4 ）： 217 - 221 .

BOURCHIER D ， WESTON P J . Randomised trial of dopamine compared with hydrocortisone for the treatment of hypotensive very low birthweight infants [J ] . Arch Dis Child Fetal Neonatal Ed ， 1997 ， 76 （ 3 ）： F174 - F178 .

EFIRD M M ， HEERENS A T ， GORDON P V ， et al . A randomized-controlled trial of prophylactic hydrocor-tisone supplementation for the prevention of hypotension in extremely low birth weight infants [J ] . J Perinatol ， 2005 ， 25 （ 2 ）： 119 - 124 .

HOCHWALD O ， PALEGRA G ， OSIOVICH H . Adding hydrocortisone as 1st line of inotropic treatment for hypotension in very low birth weight infants [J ] . Indian J Pediatr ， 2014 ， 81 （ 8 ）： 808 - 810 .

PARIKH N A ， KENNEDY K A ， LASKY R E ， et al . Pilot randomized trial of hydrocortisone in ventilator-dependent extremely preterm infants：effects on regional brain volumes [J ] . J Pediatr ， 2013 ， 162 （ 4 ）： 685 - 690.e1 .

PELTONIEMI O ， KARI M A ， HEINONEN K ， et al . Pretreatment cortisol values may predict responses to hydrocortisone administration for the prevention of bronchopulmonary dysplasia in high-risk infants [J ] . J Pediatr ， 2005 ， 146 （ 5 ）： 632 - 637 .

PATEL R M . Short- and long-term outcomes for extremely preterm infants [J ] . Am J Perinatol ， 2016 ， 33 （ 3 ）： 318 - 328 .

JOBE A H ， BANCALARI E . Bronchopulmonary dysplasia [J ] . Am J Respir Crit Care Med ， 2001 ， 163 （ 7 ）： 1723 - 1729 .

HIGGINS J P T ， ALTMAN D G ， GØTZSCHE P C ， et al . The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials [J ] . BMJ ， 2011 ， 343 ： d5928 .

毛玮莹，周建国，陈超 . 氢化可的松防治早产儿支气管肺发育不良的研究进展 [J ] . 中国实用儿科杂志， 2019 ， 34 （ 8 ）： 704 - 709 .

SHAFFER M L ， BAUD O ， LACAZE-MASMONTEIL T ， et al . Effect of prophylaxis for early adrenal insufficiency using low-dose hydrocortisone in very preterm infants：an individual patient data meta-analysis [J ] . J Pediatr ， 2019 ， 207 ： 136 - 142.e5 .

MORRIS I P ， GOEL N ， CHAKRABORTY M . Efficacy and safety of systemic hydrocortisone for the prevention of bronchopulmonary dysplasia in preterm infants：a systematic review and meta-analysis [J ] . Eur J Pediatr ， 2019 ， 178 （ 8 ）： 1171 - 1184 .

纪凤娟，殷勇，徐娟，等 . 早产儿生后早期应用糖皮质激素预防支气管肺发育不良的Meta分析 [J ] . 中国当代儿科杂志， 2017 ， 19 （ 6 ）： 638 - 645 .

汪艳 . 青蒿琥酯对氢化可的松诱导的免疫抑制小鼠模型的保护作用及其机制研究 [D ] . 遵义：遵义医科大学， 2020 .

Views

240

下载量

CSCD

Alert me when the article has been cited

提交

Tools

Publicity Resources

Immune checkpoint inhibitors combined with neoadjuvant chemotherapy and adjuvant chemotherapy in the treatment of early-stage triple-negative breast cancer： a meta-analysis

Meta-analysis of the effects of SLCO1B1 gene polymorphisms on the efficacy and safety of rosuvastatin

Meta-analysis of efficacy and safety of cabozantinib in the treatment of advanced thyroid cancer

Meta-analysis of efficacy and safety of belimumab in the treatment of childhood-onset systemic lupus erythematosus

Efficacy and safety of new oral anticoagulants in patients with nonvalvular atrial fibrillation after left atrial appendage occlusion：a meta-analysis

Related Author

YANG Chunyan

ZHANG Shaohua

LI Rongkang

PENG Lei

ZHAO Li

BIE Jun

WANG Song

LIU Kefeng

Related Institution

Dept. of Oncology， Nanchong Hospital Affiliated to Beijing Anzhen Hospital， Capital Medical University （Nanchong Central Hospital）， Sichuan Nanchong

Dept. of Urology， South China Hospital Affiliated to Shenzhen University

Dept. of Urology， the Second Hospital of Lanzhou University

Dept. of Pharmacy， the First Affiliated Hospital of Zhengzhou University

Dept. of Geriatrics， Lanzhou University Second Hospital

⁰